Effectiveness and reporting quality of blood flow restriction training in the rehabilitation of patients with upper limb musculoskeletal disorders: A systematic review

BACKGROUND: Blood flow restriction training (BFRT) is a widely studied strategy in lower limb pathology; however, BFRT research in upper limb disorders is limited. OBJECTIVE: To evaluate the effectiveness of BFRT programs on skeletal muscle mass, strength, pain, and function in upper limb musculoskeletal disorders rehabilitation and to analyze the reporting quality of the exercise content. METHODS: A literature search of the PubMed, Web of Science, Scopus, Scientific Electronic Library Online, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, and Physiotherapy Evidence Database was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from inception to May 2023. The results included randomized controlled trials (RCTs) and non-RCTs, prospective and retrospective cohort studies, case series, and case report studies of patients with upper limb musculoskeletal disorders treated with resistance exercise enhanced with BFRT and reporting at least one outcome related to skeletal muscle mass, strength, pain or function/disability. The risk of bias of the included studies was assessed using the Risk of Bias 2.0, and the reporting quality was evaluated with the Consensus on Exercise Reporting Template (CERT). RESULTS: Four RCTs, one case series, and four case report studies were included. Very low-quality studies showed a pattern of clinical improvements surpassing the minimal clinically important difference in most patient-reported outcome and physical function measures. The risk of bias in the included studies was high. The CERT revealed poor description of the BFRT programs. CONCLUSIONS: This systematic review identified limited and low-quality evidence that BFRT is effective in the physical rehabilitation of patients with upper limb musculoskeletal disorders. Additionally, the reporting of BFRT content in patients with upper limb disorders is poor. We recommend that authors use the CERT guideline when reporting the exercise protocols and results of trials investigating BFRT interventions.